Many women have problems with sex at some stage in their life. Here's a look at some forms of female sexual dysfunction (FSD) and advice on where to get help if it affects you.
According to the Sexual Advice Association, sexual problems affect around 1 in 3 of young and middle-aged women, and around 1 in 2 of older women.
To identify the reasons behind sexual dysfunction, both physical and psychological factors have to be considered, including a woman's relationship with her partner.
A reduced sex drive (loss of libido), affects some women at certain times of life, such as during pregnancy, after having a baby, or during times of stress. But some women experience it all the time.
A loss of libido can have a range of physical or psychological causes, including:
- Relationship problems
- Previous mental or physical trauma
- Diabetes – both type 1 and type 2 diabetes
- Hormone disorders such as having an underactive or an overactive thyroid gland
- Excessive alcohol consumption or drug use
- Certain medicines, such as the SSRI type of antidepressants
Libido can also fall if a woman's natural testosterone levels drop. Testosterone is produced in the ovaries and adrenal glands, so levels can drop if these are removed or they're not functioning properly.
These can be divided into two types:
- Primary – when a woman has never had an orgasm.
- Secondary – when a woman has had an orgasm in the past, but can't now.
Some women don't need to have an orgasm to enjoy sex, but an inability to reach orgasm can be a problem for some women and their partners.
Reasons why a woman can't have an orgasm can include:
- Fear or lack of knowledge about sex
- Being unable to "let go"
- Not enough effective stimulation
- Relationship problems
- Feeling depressed or stressed
- Previous traumatic sexual experience
Research is being done into certain medical conditions that affect the blood and nerve supply to the clitoris to see whether this affects orgasm.
Psychosexual therapy can help a woman overcome orgasm problems. It involves exploring her feelings about sex, her relationship and herself.
Pain during sex, also called dyspareunia can be caused by vaginismus.
Vaginismus is when muscles in or around the vagina go into spasm, making sexual intercourse painful or impossible. It can be very upsetting and distressing.
It can happen if a woman associates sex with pain or being "wrong", or if she's had vaginal trauma, such as an episiotomy during childbirth.
It can also stem from relationship problems, fear of pregnancy, or painful conditions of the vagina and the surrounding area.
Depending on the cause, it may be treated by focusing on sex education, counselling and using vaginal trainers, also known as vaginal dilators.
Vaginal trainers are cylindrical shapes that are inserted into the vagina. A woman will gradually use larger sizes until the largest size can be inserted comfortably. Some women may wish to try using their fingers instead.
Sex after menopause
Pain during sex is common after the menopause as oestrogen levels fall and the vagina feels dry.
This can affect a woman's desire for sex, but there are lubrication creams that can help. Ask your GP or pharmacist.
For further information about menopause see the NHS website (external link).
Female genital mutilation
Women who have experienced Female Genital Mutilation (FGM) can find it difficult and painful to have sex.
FGM is where female genitals are deliberately cut, injured or changed, but there is no medical reason for this to be done.
It can also result in reduced sexual desire and a lack of pleasurable sensation.
Talk to a GP or another healthcare professional if you have sexual problems that you feel may be the result of FGM. They can refer you to a therapist who can help.
To find out what is causing a sexual problem and how to treat it, a doctor, practice nurse or therapist will need to ask you questions about your medical, sexual and relationship history.
A GP or practice nurse may order tests to check for underlying health conditions.
If your problem is related to lack of hormones, such as testosterone or oestrogen, Hormone Replacement Therapy (HRT) may help.
For further information about HRT please see the NHS website (external link).
Treating other conditions, such as diabetes or depression, may also alleviate symptoms of sexual dysfunction.
Sexual therapy can help. Talk with your partner about your problem, and see a therapist together if you can. Do not be embarrassed. Many people experience sexual dysfunction and there are ways to get help.
Your GP can refer you to a therapist, or you can see one privately. Look for a therapist who is an accredited member of the College of Sexual and Relationship Therapists.
This means they will be fully qualified and able to advise on physical, psychological and medical factors that can affect sexual wellbeing.
If needed, they can also refer you to a GP or another medical practitioner who can do the required tests or examination.
The Sexual Advice Association offers sexual health factsheets on topics ranging from loss of libido to how to talk to a GP about your sexual problems.